From the Guidelines
The statement by the child's parent that indicates a need for further teaching is "I will make sure he takes his medication after breakfast every day." This statement shows a misunderstanding about the timing of ADHD stimulant medications. Most stimulant medications for ADHD (such as methylphenidate or amphetamine-based medications) should be taken before breakfast, not after, to ensure optimal effectiveness during school hours. Taking the medication after breakfast may delay its onset of action, potentially causing the child to experience symptoms during the early part of the school day when focus is particularly important. Additionally, some stimulants may suppress appetite, so taking them after eating breakfast ensures the child has already consumed an important meal. The other statements demonstrate correct understanding about side effect monitoring (insomnia and poor appetite are common side effects that should be reported) as noted in 1, the medication's effect on impulsivity at school, and its role in helping the child focus to learn new behaviors. Key points to consider when managing stimulant-associated side effects include:
- For appetite loss, the child can be given the stimulants with meals and a high-calorie drink or snack late in the evening, when the stimulant effects have worn off, as suggested in 1.
- For difficulty falling asleep, one must distinguish whether the delay in sleep onset is due to a side effect of the stimulant or from oppositionality related to the ADHD or to separation anxiety, also discussed in 1. It is essential to educate the parent on the proper administration and potential side effects of the medication to ensure the child receives the maximum benefit from the treatment while minimizing adverse effects, as supported by the practice parameters outlined in 1.
From the FDA Drug Label
To report SUSPECTED ADVERSE REACTIONS contact Tris Pharma, Inc., at (732) 940 0358 or FDA at 1-800-FDA-1088 or www.fda. Common adverse reactions: tachycardia, palpitations, headache, insomnia, anxiety, hyperhidrosis, weight loss, decreased appetite, dry mouth, nausea, and abdominal pain.
The statement by the child’s parent that indicates a need for further teaching is:
- “I will make sure he takes his medication after breakfast every day.” This is because the drug label recommends taking the medication before breakfast and lunch for pediatric patients 6 years and older 2.
From the Research
Statement Analysis
The following statements by the child's parent are analyzed to determine which one indicates a need for further teaching:
- "I should report insomnia and poor appetite to his provider."
- "I will make sure he takes his medication after breakfast every day."
- "This drug will make him less impulsive while he’s at school."
- "This medication will help my child focus so he can learn new behaviors."
Adverse Effects and Medication Administration
According to the studies, methylphenidate, a central nervous system stimulant, can cause adverse effects such as poor appetite 3, 4, 5. However, insomnia is not consistently reported as a significant adverse effect in these studies. The statement "I should report insomnia and poor appetite to his provider" is partially correct, but the parent may not be aware that insomnia is not a commonly reported adverse effect.
Medication Effectiveness
The medication is expected to help the child focus and reduce impulsivity, which is consistent with the statements "This drug will make him less impulsive while he’s at school" and "This medication will help my child focus so he can learn new behaviors" 5, 6. These statements indicate an understanding of the medication's intended effects.
Conclusion is not allowed, so the analysis continues
The statement "I will make sure he takes his medication after breakfast every day" does not necessarily indicate a need for further teaching, as it shows the parent is taking steps to ensure the child takes the medication as directed.
Need for Further Teaching
Based on the analysis, the statement that indicates a need for further teaching is not explicitly clear from the provided options. However, the parent's understanding of the medication's adverse effects and intended effects is mostly consistent with the available evidence 3, 4, 5, 6. The parent may benefit from further education on the potential adverse effects of the medication, particularly regarding insomnia, which is not consistently reported in the studies.